Provider Demographics
NPI:1851942320
Name:GRANT, MARIAN (LPCA)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 JOE TOM GRANT RD
Mailing Address - Street 2:
Mailing Address - City:GLENS FORK
Mailing Address - State:KY
Mailing Address - Zip Code:42741-7823
Mailing Address - Country:US
Mailing Address - Phone:270-378-1782
Mailing Address - Fax:
Practice Address - Street 1:110 HELM ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-1496
Practice Address - Country:US
Practice Address - Phone:270-506-2967
Practice Address - Fax:270-900-1674
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251210101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional